Is it Yes or No?

The question "do vaccinations cause autism?" is a very important question and in general, for the vast the majority of children, the answer is no. However, let us examine this question carefully, weighing what is known in terms of evidence and medical opinion related to this issue. And let's look at some of the cases where vaccination has been cited as a causal factor in an autism diagnosis. Also, let us consider if there is a subgroup of children, who may be at risk of regressive autism due to vaccinations. But first, let's go back to what caused this whole issue to blow up......actually we will return, to the time just before this. 

Autism AwarenessCredit: Flickr helpingting

For years, there has been rumblings from parents citing vaccinations as a cause of their childs developmental disorder. While there is no doubt, that vaccines can cause side effects in some people, the overall official, medical view, was that vaccination has been used as a scapegoat by parents, as vaccinations usually occur at about the same time, autism symptoms appear.

In the past however, autism has been diagnosed simply on symptomatology, related to impairments in 3 main area. Theses being:

 1. Impairment in social interaction

2. Impairment in communication

3. Restricted and repetitive interests, activities and behaviours

There was no medical tests available, which could diagnose autism medically, except for some syndromic genetic disorders, where autism may also occur. These include chromosomal abnormalities, like Fragile X, metabolic diseases like phenylketonuria and susceptibility loci e.g. reelin glycoprotein (Sporadic or inherited). More recent research however, has included many new lines of evidence, but more about that later.

Fear and Panic

The vaccination hypothesis of regressive autism, exploded in 1998, when British gastroenterologist Andrew Wakefield and colleagues published a paper in the prestigious medical journal, The Lancet, that described 8 children, whose first symptoms of autism appeared within a 1 month period of receiving the MMR vaccine.

Like any medication, vaccines can cause side effects. The MMR vaccine for example, is known to cause:

  • Fever (up to 1 person out of 6)
  • Mild rash (about 1 person out of 20)
  • Swelling of glands in the cheeks or neck (about 1 person out of 75)

More serious MMR side effects are: seizures resulting from fever and low platelet count. Serious allergic reactions, however occur in less than 1 out of a million doses. These may include: deafness, long-term seizures, coma, or lowered consciousnessand permanent brain damage (1.).

AutismCredit: Flickr helpingting

Wakefield however, caused an uproar, claiming that the 8 children in his study, showed symptoms of intestinal inflammation; lymphoid nodular hyperplasia when examined by endoscopy. It was Wakefield's contention, that the MMR vaccination caused the intestinal inflammation, leading to the development of peptides in the bloodstream and then the brain, affecting development.

Needless to say, many parents panicked. Vaccination for a start, feels counterintuitive. How many parents are comfortable, having a sharp needle jab their child? Many already uncomfortable with the concept, but entrusting the weight of science and medical opinion, felt cheated, duped, and plain confused. What to do? How to decide, what was the best thing for our precious offspring?

Vaccine Use Fell

Own WorldCredit: Flickr libertygraceo

In Britain and many other countries, vaccination rates dropped like a stone, as Wakefield said:

“I can’t support the continued use of these three vaccines, given in combination,” he said, “until this issue has been resolved.”

Measles made a comeback. The year 2007 saw 971 measles cases in England and Wales; this was the largest occurrence in measles cases since records began in 1995. And measles can cause death, especially in vulnerable populations like babies, the elderly and immunocompromised patients.

Later it was revealed, that Wakefield's research methods were methodologically compromised and his conclusions speculative. But even more damaging, was the revelation that Wakefield owned a patent for a single measles vaccine. And journalist Brian Deer, uncovered the fact, that Wakefield was paid by lawyers putting together a case against MMR manufacturers. Wakefield failed to disclose this clear conflict of interest.

Mercury and Toxins

However, there were also other claims related to vaccination. Thiomersal was used in many vaccines as a preservative from the 1930s. This mercury-based preservative, was also said to contribute to the development of autism, and other brain development disorders. Concerns especially centered around the "multi-dose" nature of vaccination. An explosion of lawsuits were filed by parents, seeking damages, stating toxicity from vaccines, including thiomersal. However to cut a long story short, the scientific consensus is that no significant evidence can establish thiomersal as the cause of autism, or other neurodevelopmental disorders.

From 1988 until August 2010, 5,632 claims relating to autism were made to the U.S. Court of Federal Claims; 738 cases were dismissed without compensations made, and the remaining cases are pending. One very important case did receive compensation, and we will turn now to that.

The Hannah Poling case

Red haired Hannah Poling, had an uncomplicated birth and developed normally, until she  received five vaccines. Two days later, Hannah was lethargic and irritable, then febrile. Ten days later a rash, consistent with vaccine-induced varicella developed. There was notable psychological and neurologic deterioration and she was diagnosed with encephalopathy caused by impaired mitochondrial function.

The father of Hannah Polling, Dr. Jon Polling is a Neurologist, her mother Terry Poling is a registered nurse, and an attorney. These parents obviously had the ability and wherewithal to pursue this case through the court and to supply necessary evidence. The court conceded in this particular case, that vaccines aggravated an unknown mitochondrial disorder. Which brings us to mitochondrial autism.

Mitochondrial Autism 

TantrumCredit: Flickr cakeeater23

In 1998, J. Lombard published an article in the journal Medical Hypotheses, proposing that autism may be a mitochondrial disorder [The mitochondria are often called the powerhouse of the cell, they provide us with the energy we need for our body and brain]. Slowly evidence began emerging, that many mysterious neurological disorders had a mitochondrial component. For example, scientists from the RIKEN Brain Science Institute in Japan, in research published in Molecular Psychiatry in 2006, claimed that there is good evidence of a link between Bipolar disorder, and mitochondrial dysfunction. And mitochondrial dysfunction plays a large part in Huntington's disease due to the hyperativation of AMPK (energy sensor that maintains cellular energy homeostasis).

In 2011, a systematic review and meta-analysis was conducted by the journal Molecular Psychiatry (2012) related to autism and mitochondrial dysfunction. Prevalence of abnormal biomarker values of mitochondrial dysfunction was found to be high, with significant difference found in biomarkers like: lactate, pyruvate, carnitine and ubiquinone , compared to controls. Also 79% of children had no genetic abnormalities, inferring that secondary mitochondrial dysfunction was involved.

Richard Kelley, MD, PhD, from the Kennedy Krieger Institute, Department of Pediatrics, John Hopkins Medical Institutions, has been involved in autism related , mitochondrial testing. He states, that over the last 15 years, mitochondrial complex 1 has been shown as a significant cause of regressive autism cases. Children with this secondary form of mitochondrial disease have experienced significant episode/s of injury, during critical developmental periods. Kelley proposes some possible treatments and testing procedures (see here). Kelley also says:

"regression often can be dated to a specific event, most often a simple childhood illness,such as otitis media, streptococcal pharyngitis, or viral syndrome, or, rarely, an immunization, most often the MMR vaccine or the former DPT. The common feature of all identified precipitants is inflammation"

Words which do go a long way toward vindicating the experiences of many parents.

However, treatments for secondary mitochondrial dysfunction are generally experimental, as there are many complex factors. Other research in those suffering autism, have found mtDNA overreplication and significantly lower levels of: complexes III and V in the cerebellum,
complex I in the frontal cortex and complexes II, III, and V in the temporal cortex. The abnormal energy metabolism, is likely to cause greater oxidative stress and inflammation, and may lead to further dysfunction. The number of mitochondria in each cell, depends on the cellular energy demands; high energy is demanded by muscle, liver and brain.

It is evident that, mitochondrial dysfunction is becoming more recognised as an important component in disorders like autism. However, it is not currently known which children may have a predisposition to such dysfunction and if vaccination is a significant risk factor for such groups. More research is needed. However, Dr. Kelley recommends that vaccinations should proceed, "providing anti-inflammatory protection". And Hannah Polling mentioned above, was able to recover sufficiently with early intervention, cofactor vitamin therapy and Levocarnitine (2.). So there is hope.

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